Two simple tests that take less than a minute can help diagnose fibromyalgia in patients with chronic pain, a recent study suggests.
Results of the study published in the Journal of Evaluation in Clinical Practice suggest that experiencing pain upon pinching the Achilles tendon and a positive response to the question, “Do you have a persistent deep aching over most of your body?” are good indicators of fibromyalgia.
The study is titled, “A simple screening test to recognize fibromyalgia in primary care patients with chronic pain.”
Fibromyalgia affects about 3.4% of women and 0.5% of men in the United States. It is characterized by chronic widespread pain and associated with several secondary conditions, including sleep disturbances, fatigue, psychological distress, chronic pelvic pain, and irritable bowel syndrome, among others.
Because of the many different symptoms it may present, fibromyalgia can be challenging to diagnose. The process often takes two to three years and three to four evaluations by different medical teams to reach a correct diagnosis.
Guidelines from the American College of Rheumatology (ACR) indicate that fibromyalgia should be diagnosed based on widespread pain experienced for more than three months and pain upon palpation of 11 of 18 tender points. The use of patient self-reported questionnaires focused on other symptoms besides pain also has been proposed to help in the process.
However, these diagnostic strategies and other alternative guidelines that have been proposed still fail to achieve a fast and accurate diagnosis, highlighting the need for simpler screening tests.
Led by Kim D. Jones, PhD, FNP, FAAN, professor at the Oregon Health and Science University in Portland, a team of researchers tested if three clinical measures — blood pressure (BP) cuff‐evoked pain, digital palpation evoked pain, and a single question about “persistent deep aching” — could be used as indicators of fibromyalgia.
The study included 352 patients, of whom 70% were women, who were evaluated in routine examinations at two primary care practices. A total of 52 patients had a diagnosis of fibromyalgia, 108 had chronic pain but not fibromyalgia, and 192 patients had no pain-associated conditions.
The study found that patients with fibromyalgia showed significantly greater sensitivity to digital pressure and BP-evoked pressure pain compared to patients with chronic pain but no fibromyalgia. When questioned about deep ache, more fibromyalgia patients responded positively than the other groups of participants.
Additional analysis showed that patients who had right Achilles tenderness and who endorsed the deep-aching question had an 11 times greater chance of having fibromyalgia. The use of these two factors combined was found to identify fibromyalgia patients with 64% sensitivity and 86% specificity.
“These results suggest that 2 tests, taking less than 1 minute, can indicate a probable diagnosis of FM in a chronic pain patient,” researchers wrote.
Despite the great potential that these diagnostic measures may represent, they cannot be used alone to make a final diagnosis of fibromyalgia, the researchers emphasized.
“In the case of a positive screen, a follow-up examination is required for confirmation or refutation,” they wrote.
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